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Author here. Issue #4 is now live — pharmacy benefit managers.

Three companies process 80% of US prescriptions. The FTC spent two years investigating them and documented $7.3B in specialty drug markups at PBM-owned pharmacies alone. Ohio's state auditor found $224.8M in spread pricing extracted from one state's Medicaid program in a single year.

Six mechanisms, $30B/year booked conservatively. Running total across four issues: $128.6B.

github.com/rexrodeo/american-healthcare-conundrum

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